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Vulnerable Persons Registry (VPR)

  1. parent, sibling, friend, etc.

  2. What vulnerabilities do you experience? Please select all options that apply.*
  3. For example: If you have a mobility disability, please indicate if you use a cane, a walker, a wheelchair or another mobility device.  

  4. Is home dialysis performed in your home? *
  5. Do you own a pet?*
  6. Terms and conditions

    I allow the Vulnerable Persons Registry Program of the Municipality of Jasper to provide the information I included in my Vulnerable Persons Registry (VPR) registration form to local Fire, Emergency Medical Services and Emergency Management for use during emergencies. I know that it is important for me to ensure that the VPR program has accurate and up-to-date information at all times. I understand that I still need to call 9-1-1 in an emergency and I am also responsible for having an emergency plan in place in order to be prepared to remain safe for at least three days.

    I recognize that the VPR does not guarantee my safety, but provides an added safeguard where local emergency service groups will make every effort to increase the possibility of my safety during emergencies. I agree to release the Municipality of Jasper and its elected officials, employees and agents from and against all claims, demands, actions, suits, loss, damage, costs, charges and expenses (collectively “Claims”) which I may incur, suffer or be put to because VPR is unable to guarantee my safety or otherwise in connection with the VPR.

    I understand that if I am approved, my information will be available to authorized local emergency service groups. I also understand that I will be notified once my information will be made available to those authorized emergency service groups. I further understand that as part of the program, twelve-month updates are required and the Municipality of Jasper will contact me to complete an update; however, if unsuccessful the Municipality of Jasper will remove me from the VPR. I know that I can also request to be removed from the VPR at any time.

    Only the registrant or legal guardian is legally able to authorize the choice to register. By clicking 'Accept' below, you are authorizing that you agree to the above information and would like to register

  7. Accept terms and conditions *
  8. Leave This Blank:

  9. This field is not part of the form submission.